Months deep into the global pandemic that has shaken almost every aspect of American life, medical personnel at Geisinger Medical Center and Evangelical Community Hospital have been pulling together to give the best possible care to COVID-19 patients — and to each other.
In his role as the ECMO (extracorporeal membrane oxygenation) coordinator at Geisinger Medical Center in Danville, Evan Gajkowski, RN, has been on the front lines of the coronavirus pandemic, making sure that the most extreme COVID-19 positive patients in the intensive care units receive support to keep fighting.
As the only hospital within a large region of central Pennsylvania that offers this complex treatment, Geisinger has received many of these volatile COVID-19 cases over the last few months.
According to Gajkowski, the treatment requires careful attention to each individual, determining if they are the right candidate: “We’re definitely picking the right patients, when and how to intubate.”
The treatment was implemented at Geisinger in 2015, and since then, they have used it on more than 250 patients. In response to COVID-19, Gajkowski said, “We have seen a large increase in the amount of calls.”
During the first few months, he said Geisinger hospitals had “two full ICUs of COVID-19 patients. It was difficult. We had to go in every day and take care of these very sick people, and their family members weren’t around. We were all garbed up in PPE the entire day. Some of the staff would share with me that they were in the units for 12 hours a day.” They were grateful for an outpouring of community support, and family members who would bring food in for the staff.
Meeting mental and emotional needs
Across the Valley, medical professionals like Gajkowski have been serving tirelessly on the front lines of the COVID-19 crisis. The heightened response to an already demanding career, stretched out for months, can present unique mental and emotional challenges for them. As they seek long-term ways to cope with both caring for patients and protecting their families, local medical facilities have stepped up their outreach to provide peer support and resources to assist.
Dr. Charlotte Collins is director of Geisinger’s center for professionalism and wellbeing, under which a program called RISE (resilience in stressful events) was scheduled to launch sometime in 2020 to assist caregivers dealing with mental or emotional trauma.
“We had several steps left to go — quite a few actually,” she said, “but when COVID hit, we said we need this now.” They modified their plan and launched it within three weeks.
One hundred people across the system, carefully vetted, were trained to become volunteer peer supporters, helping colleagues who were struggling in the complex fight against this aggressive, mystery virus.
Collins said they have worked hard to remove the stigma surrounding mental health issues, and to remind everyone that “It’s ok to not be ok right now, to reach out.”
It’s a message that is especially critical for healthcare workers, who Collins said “are pretty stoic and expect themselves to manage whatever comes their way. So we’ve been working a lot to try to talk about the importance of taking care of yourself and taking advantage of the resources that we have.”
After training members in 2018 and 2019, UPMC activated its Critical Incident Stress Management-As Soon As Possible (CISM-ASAP) program in March. According to Jackie Baker, behavioral health therapist III and program coordinator at UPMC in the Susquehanna Region, the team began reaching out to all locations and satellite offices and also broadcast a Town Hall meeting about the program, and to discuss symptoms of burnout and tips on self-care. Weekly emails were distributed with tips and thank-you cards, teams met with departments offering space for staff to process COVID-19’s impact, and they encouraged the use of the Employee Assistance Program for those who could benefit from additional resources.
“Anticipation of the unknown, fatigue, frustration with no ‘end date’, and burnout are all top of mind for everyone right now,” she said, “not just health care workers.”
Baker said they continue to focus on “the need of ongoing support and reassurance” as they build their ASAP team membership numbers to meet the needs of their colleagues, as well as to be more visible on the campuses.
“This will also allow us to take time for ourselves and self-care so we can be in the best condition ourselves to help others.”
It’s not just those professionals dealing directly with COVID-19 patients who have been affected by the pandemic. As Collins shared, “there are a lot of front lines” in the medical community, and all departments have been touched in some way.
In the early part of the year, Geisinger facilities were performing 10 to 12 percent more surgical operations and procedures than they did the previous year. But as COVID-19 guidelines were issued, that growth spurt ended.
“We essentially overnight began to cancel everything but urgent operations,” said Dr. Alfred Casale, chief medical officer for surgical services and chair of the Geisinger Heart Institute. He said in one week they dramatically reduced their services to about 26 percent. They continued to reach out approximately every two weeks to patients on the waiting list, Casale said, “to be sure the delay was not negatively affecting their health.” Around the first week of May, they began to slowly, gradually and selectively do more and more operations. Casale uses the analogy of “a dimmer switch”, explaining that they were able to adjust things up or down, depending on the needs.
Despite the extra precautions they had to take, Casale is proud of the staff’s hyper-focus that helped to reduce both risk and anxiety, and to keep meeting patients’ needs.
“The professionalism, volunteerism among our teams, has really been amazing,” he said. “Our nursing staff in the highest pressured environments of emergency rooms, operating rooms, and ICUs, have been among the most reasonable, calm groups in the whole place, because they have got the confidence that their skills, our support, and the equipment we’ve been able to provide, have made them safe. It was all about an early aggressive response, transparency about what we’re doing.”
Geisinger was also in a good position, simply because of its size. With facilities spread out over 43 counties in Pennsylvania and into New Jersey, they never had to worry about whether they would have enough space for patients if the pandemic grew.
“It really was a great example of how being a large system with a lot of flexibility…made sure nobody got overwhelmed,” Casale said.
Importance of community
But even as a smaller health care system, Evangelical Community Hospital in Lewisburg has experienced the benefits of the close relationships their staff share with one another.
Shira R. Vergauwen, director of Care Coordination, said the camaraderie she has seen facility-wide, even at a distance, reminded her that “We’re all in this together. That’s a source of comfort for me.”
Employees at Evangelical have continued to pitch in wherever they could, and have checked in with one another via Skype, Zoom and other technology.
“It is very communicative here,” Vergauwen said, “there are a lot of true friendships, more than just work relationships.”
“Our commitment as an organization to employee wellbeing hasn’t changed,” said Rachel Smith, vice president of People and Culture at Evangelical. It simply became more heightened as they moved through the COVID-19 pandemic and continue to do so. Now, as the response continues, Smith said they are looking for ways to respond to the specific needs that come to their attention.
For example, with Evangelical workforce being 80 percent female, they have been focusing on the specialized needs of women in the workforce – who also typically fulfill much of the caregiving responsibilities in their home.
Evangelical created “serenity rooms” to give their employees a place to rejuvenate, and communicated with them daily and even multiple times daily, “So they could feel connected, not only to what was happening operationally but also be reminded how important it was to self-care,” Smith said, adding, “We can’t provide exceptional patient care if we can’t provide exceptional employee support, at work and home.”
Smith said the results of a recent survey distributed to their employees will show what has worked so far and what they can develop in the future to continue supporting their employees for the long-term.
Vergauwen, whose husband also worked in the COVID-19 unit during the peak of the pandemic, has two school-aged children.
“They would see my husband and me coming home and taking the precautions that you need to take when you work in an environment where COVID is present,” she said. “It became normal for them and for us, but it became difficult to manage the stress of the department in unchartered territory, as well as managing a household in unchartered territory.” She also assists her elderly parents.
“It was a lot of ‘new’ for me,” she said, “and it was at times very stressful, and it does tend to take an emotional toll, and it takes a physical toll.”
Working directly with COVID-19 patients, Gajkowski said he especially keeps his guard up and has even quarantined himself from his wife, kids and aging parents. In fact, with his wife also being a healthcare worker, and his brother and sister-in-law also working with COVID-19 patients, they made a commitment to “not be selfish” he said, which meant the cancellation of normal summer trips and distancing themselves as much as possible from others.
Paula Zemaitis, physician assistant at Geisinger Convenient Care in Shamokin Dam, has three small children at home, so the concern of possibly exposing her family to COVID-19 – or any virus for that matter, she said, “is at the top of my mind.” But that’s not necessarily a bad thing.
“A little fear is good, it keeps me on my toes, makes me sure that I’m washing my hands constantly, that we all have on our face masks,” she said. When she arrives home each day, that fear is what reminds her to take off her shoes at the front door and immediately head inside to put her clothes in the laundry and take a shower.
It’s this kind of healthy fear that will help medical professionals through the stress and anxiety of the pandemic’s continued effects, as well as the threat of a second wave in the fall.
Right now, Gajkowski said their ICU has dwindled to just a small section for COVID-19 patients. In this downtime, he said it’s important to take a step back, review the past few months, and prepare for the future.
“Banding together and supporting staff members is the way we’re going to get through it and prepare ourselves for the second round,” he said.
As Geisinger’s surgical department expects to catch up to all backlogged procedures by Halloween, Casale said they continue to be vigilant and organized, prepared for the threat of a second wave of COVID-19 that could set back surgical dates yet again.
“We know that the line between ‘ok’ and a second surge…can be very high,” he said, adding that he is careful to draw the “line between conscientious, watchful concern and panic-stricken dismay.”
“We’re very alert, we’re very conscious,’ he said. “Is it concerning? Absolutely. But it is concerning in a way that’s also reassuring because we know the whole team’s paying attention. It’s very unlikely we’re going to be surprised by something.”
“I think we still have a little bit of a fear of the unknown,” Zemaitis admitted.
However, she credits a dedicated staff and organized response for reducing the anxiety that could have surrounded such an unprecedented situation.
“In the midst of chaos, if you have a little bit of a plan and organization, it really helps to ease your mind,” she said.
“We still don’t know 100 percent the whole scope of this virus,” she added. And that’s why it’s important to stay educated and take the necessary precautions – “making sure we’re sticking with the game plan, so we don’t slip up.”